The Zambia Report – May-15

What’s the best way to fulfil our plan to hand over responsibility for Kit Yamoyo to local organisations? With scale-up finally getting underway, we decided that a trip to Zambia once a quarter, with remote support in between, would offer the best chance of success. We were last there in Jan/Feb-15 (as reported here). By the end of April, we were back again, to the usual Zambian welcome. When Jane explained our new modus operandi to an interested party, he said “Ah, I see, you go back once a quarter for fire-fighting”. “No”, quipped Jane, “we go back for fire lighting!” And, as with most good jokes, there’s a lot of truth in that: our top priority wherever we happen to be, is to ensure ORS and Zinc become easily available across Zambia. One of our key tasks now, is to make sure this stays at the top of the list for everyone who can help make that happen. We can’t do that by staying permanently ourselves. But we can’t leave Kit Yamoyo to the vagaries of the market quite yet.

Our first meeting was with our counterpart organisation, Keepers Zambia Foundation, and it was quite inspirational. They are leading a project we co-designed with them last year, to tackle the most remote areas in Zambia, where childhood malnutrition and stunting is at its worst. Since the KYTS-ACE project started in Feb-15 (7 months late) KZF have visited all 14 of the districts covered by the SUN programme (Scaling Up Nutrition). This is a phenomenal amount of travelling (see map). During these visits to key stakeholders – those crucial to the success of the Kit Yamoyo scale-up – the KZF team introduced the project and showed product samples (full production won’t start until Jul-15). They invited ideas to contribute to the scale-up plan in each district. KZF found enthusiastic support everywhere they went, which isn’t surprising given that less 1% of children with diarrhoea are getting the recommended treatment and diarrhoea is a top killer and cause of stunting in these areas. The imminent arrival of Kit Yamoyo was greeted with huge support – and a few questions as to why this hadn’t been offered sooner!

The districts of Zambia with the SUN Programme districts mark red

But back to the ‘fire-lighting’: it was a great disappointment when we arrived to find that Kit Yamoyo assembly had stopped a few weeks previously, due to a lack of soap. In fact, Pharmanova had no kits left in stock. This was due to the fact that their soap supplier (in India) changed their terms of business, requiring a minimum order of 100,000 tablets and longer lead times.

With a bit of lateral thinking and stakeholder liaison, we managed to fill the immediate shortfall by introducing two existing NGO customers to each other: Marie Stopes International in Zambia are currently selling around 600 Kit Yamoyo a month. They had 4 months’ supply in stock and agreed to sell a part to CARE, who are running a pilot of ‘Community-based Distributors’ (CBDs) for a range of products – including Kit Yamoyo.

However, wholesalers in Lusaka and Eastern Province were out of stock with orders unfulfilled. Simon went into overdrive to try and solve this problem. Who uses small soaps? Hotels. Coincidentally, Simon had just met the head of Protea Hotels at the Queen’s Birthday celebrations, and contacted him to see if they had stock they could sell to Pharmanova. Unfortunately he didn’t but he suggested another source. Within a day, we had put Pharmanova in touch with a local stockist and assembly had re-started, albeit with soap that cost twice as much as the soap from India – but worth it as a stop-gap. This is just one example of why we are pushing for local manufacture as far as possible – and we are still trying to get a deal in place for a locally-made soap. Meanwhile, two days later, Eastern Province wholesalers got their supplies, orders were flowing to the Lusaka wholesalers and the Pharmanova sales team were on the phone proactively seeking orders.

It would easy to be dispirited by these bottlenecks; during our last visit production had stopped due to a problem with the supply of zinc! However, launching a new product is fraught with difficulties. One is the fact that demand builds slowly; initial production cannot be continuous and so lacks momentum. Erratic supply leads to a fall off in demand – and there is a danger of a vicious spiral.

At this point, in steps the fire-lighter we need: by early April the order for 452,000 co-packs for the Zambian Government (GRZ) was finally in. This will ensure continuous manufacture and assembly over the coming year, providing Pharmanova with the ‘anchor client’ they need. They will be able to switch between two product formats, depending on market demand: the new GRZ branded co-pack for health centres in SUN areas, and the retail version, Kit Yamoyo. On Monday 13-Apr-15 the ORS packaging machine at Pharmanova started producing the 200ml sachets for the GRZ order. The machine produces 14,000 sachets a day so will be working full-time for 6 months to produce the 1.8million sachets needed. The process is not entirely automated so needless to say, Pharmanova is doing its bit for job creation.

Zinc production also got underway during our visit although full-scale production will not start until Jun/Jul-15. The last component on order arrives then – amber PVC packaging, from India – another unavoidable import, triggered by the GRZ order, albeit some 2 months late. Delays like this have huge knock-on effects for projects. We sat down with KZF staff, as part of the ‘counter-part’ training, and rescheduled no less than 65% of the activities planned!

Another fire we had to relight was a nascent deal with a national supermarket chain in Zambia – which we hinted at in a previous post. We will be able to announce this shortly. We were hoping sales and promotions would start with this supermarket in Jun-15 but this has now been postponed to Aug-15 due to the above delay. The big news is that they want to take both of the new Kit Yamoyo formats: the flexi-pack and the screw-top. This is very exciting as it will give a real market test on pricing: will people pay more for the screw-top when it is presented next to the flexi-pack on the supermarket shelves?

Simon was also able to move forward with the ‘techie bits’ of the project, spending time with KZF staff who use the tablet system and with the system builders, Dimagi. This tracks retailer responses to Kit Yamoyo, as well as stock, sales, and eventually the voucher system.

KZF had collected a ‘Contacts’ database from their field visits to the SUN districts, and the obvious place for this was on the tablets. Now all fieldworkers can add to them or amend them with all additions and amendments shared across all the tablets.

Most of the development work went into a new ‘Monthly monitoring’ module which will help with the process of managing the monthly calls to retailers, due to be launched at the end of May-15.

Although this monthly calling process collects valuable data, the real value is that retailers appreciate the call. It gives them a chance to highlight challenges they may be facing and acts as an early warning system when things are going wrong. There are many examples of this but one that stands out was a retailer who had stopped selling Kit Yamoyo because the drama group promoting the kit had come to him for samples to use in a drama session and had not paid for them or replaced them. He told the caller, he wasn’t going to stock Kit Yamoyo again until these kits were replaced. How else would we have known about this problem? The kits were replaced the next day and the drama groups duly reprimanded!

In parallel with the tablet development, a UK-based volunteer, Abbott Katz who runs the Spreadsheet Journalism blog, has been busy building an Excel-based dashboard which will take a daily snapshot of the data collected on the tablets and report on key indicators including:

Percentage of retailers contacted this month (the target is to contact all retailers at least once a month)

Average weekly sales

Wholesale and retail prices

Stock levels

This is an exciting development and will give near real-time feedback to the whole team including those working hard to collect the data.

And finally… a real highlight of our trip was meeting Rosie. Rosie is 10 years old and attends the American International School in Lusaka. She’d done her Grade 5 project on diarrhoea and had interviewed ColaLife and visited local clinics as part of her research. Rosie deserves her own blog post. This will appear shortly but meanwhile, here is Rosie’s diarrhoea song! It’s good to know that when it comes to lighting passions for sticky health issues among the next generation, we are not alone!